Erickson Tribune

Health Secrets

UPDATED: Tuesday, February 27, 2007

That leg cramp IS important

Posted on Tuesday, February 27, 2007
 

The hidden dangers of PAD

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

One of the most prevalent cardiovascular conditions is peripheral artery disease, PAD for short. It’s a condition in which the arteries in the legs have poor circulation, which can lead to various problems.

In the long term, PAD is associated with heart attacks and/or strokes. And it has a more immediate hazard: its effect on your quality of life.

Eric Lieberman, M.D., a consulting cardiologist to the Riderwood community in Silver Spring, Md., built and managed by Erickson, says, “People retire with images of playing tennis or golf, or even taking up a new activity, and then leg pains keep them from truly enjoying themselves.”

Lieberman says, “PAD is a very underdiagnosed condition.” Experts aren’t sure how widespread PAD is, but estimates are that PAD affects between 8 to 12 million Americans. We do know this much: PAD is more likely to occur as we age. It starts developing at age 50 and becomes increasingly common and noticeable after age 65. It’s estimated that at least 20% of Americans over age 70 have this condition.

Easy to miss
The main problem with PAD is that in the majority of cases there are no symptoms at all. The one that does occur involves walking— and most people just dismiss it.

“People find they have trouble walking any great distance, or when they walk they develop leg cramps. That’s called claudication,” says Lieberman. “And people say, ‘Oh, it’s just arthritis,’ or ‘I’m out of shape,’ or simply, ‘I’m getting old.’ So they don’t think to report the problem to their doctor.”

In the past, many physicians didn’t talk much about the condition because they simply didn’t have any great treatment options to offer. So they hesitated to discuss PAD at all, except with patients whose condition was severe or obvious.


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Simple, easy diagnosis
The good news is that doesn’t have to happen. The first step is diagnosis—and PAD is relatively simple to detect, using a blood pressure test called an ankle brachial index (ABI). “It’s a blood pressure reading (using a slightly modified device) on your leg.

You lie on a table and we take the blood pressure both in your arm and in your leg,” Lieberman explains. “Since both your arms and legs are using the same circulatory system, both readings should match exactly—or at least be fairly close.”

On your feet
Your risk is heightened if you smoke or have diabetes, both of which affect your circulatory system.

Fortunately, treatment options for PAD keep improving. “A good walking program is still the cornerstone of effective PAD treatment,” says Lieberman. “It stimulates the growth of new blood vessels, called collaterals. Walk until your legs start to cramp, then rest, then start again.”

The enclosed walkways and well-equipped Fitness Centers at communities built and managed by Erickson are very conducive to a walking program, but if you don’t have access to them, you can get a home treadmill. Better yet, join a class that walks an indoor track or a mall. The latter is an option Lieberman heartily recommends: “It’ll give you a commitment to maintain your exercise and it provides social interaction.”

If bad knees or other problems make walking less viable, talk to your doctor or a physical therapist. The odds are they can recommend options like a recumbent bike and pool walking. The latter is good, Lieberman says, because it provides support while “the water gives you resistance to walk against.”

Other treatments
Improved treatments for PAD keep appearing. Lieberman says, “A drug called Pletal has been shown to improve walking distance in people with PAD.”

The less invasive procedure used for heart disease—balloon angioplasty—has been adapted for unclogging leg arteries. “You’re in and out in 24 hours instead of the three-month recuperation you used to face,” says Lieberman.

Such catheter-based technologies may allow patients to avoid major surgery. Of course, always talk to your doctor about these options.

And that’s the best advice of all. Start talking to your doctor. Get that simple leg pressure reading and begin a good PAD prevention program.

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What is your risk for PAD?
There are 8 to 12 million Americans at risk for PAD. Are you one of them? Take a look at the following checklist:

Age—Your risk rises at age 50, and by age 70, 20% of adults have PAD

Family history—You may be more prone to problems like high cholesterol

High cholesterol—Your risk of PAD rises 10% for every 10 point increase in your total cholesterol

Smoking—Increases your risk two to five times, with 90% of PAD patients being current or former smokers

High blood pressure—Doubles your risk

Diabetes—Your risk for PAD is three to four times that of the average person

Obesity—Increases your likelihood of other risk factors, like high cholesterol and diabetes

High homocysteine levels—The lack of certain B-vitamins, like folic acid and B-12, can boost levels of homocysteine (an amino acid)

While you can’t change your age or family history, you can change your other risk factors and perhaps lessen the effect age or family history has on your PAD risk. Talk to your doctor before making any changes.

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